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General NPI Number Information
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NPI Number | 1205950995
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Entity Type | Individual
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Provider Name | MICHELE CARTER RAVENEL DMD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 173 ASHLEY AVE BSB 124 COLLEGE OF DENTAL MEDICINE
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City | CHARLESTON
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State | SC
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Zip | 29425-0001
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Country | US
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Telephone | 843-792-7258
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Fax | 843-792-2150
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Provider Business Mailing Address
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Address Line | 1466 HEADQUARTERS PLANTATION DR
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-3103
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Country | US
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Telephone | 843-557-0696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | ID0016
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License Number State | SC
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